A car birth, a bus birth, a yurt birth, an en caul birth, and a mother-supported birth

This reminds me of a Dr. Seuss book...

I can give birth in a car
I can give birth in a bus
in a yurt
with the caul
with my mom

A car birth
An Australian family pulls over onto the side of the road and has their baby in front of an apple shop.

A bus birth

An Ohio family has their baby in a converted school bus. 

A yurt birth
Through June 18, you can have your baby in this fully-equipped yurt in the middle of the Amsterdamse Bos. No charge to use the yurt. Sponsored by Birth Project: Look Again, which is hosting a number of activities in June. More information here.

An en caul water birth
The father lifts the caul off his daughter's face after she is born. Watch the video and read the birth story.

A mother-supported birth
A mother supports her daughter having her second home birth

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Nous sommes les freebirthers by Stéphanie St-Amant

I'm up at 3 am with either food poisoning or a stomach bug...nothing better to do than hop online and distract myself.

At Eric's family reunion 2 years ago, I remember the exact same thing happening...mysterious gastro-intestinal malady, middle-of-the-night websurfing, puke bowl next to me on the couch. And unbeknownst to me, I was also pregnant!

I don't think that's the case this time around, unless my Mirena IUD has failed me. This can happen, although it's rare. A friend of mine and mother of 8 has gotten pregnant once on birth control and TWICE on IUDs! Both times the IUD came out with the baby.

Anyway...

I came across a fantastic article by Stéphanie St-Amant: Nous sommes les freebirthers. Enfanter sans peur et sans reproche ("We are the freebirthers: Giving birth without fear and without reproach" published in Recherches féministes 27.1, 2014, p. 69-96). The link leads to a free PDF and requires a free registration to Acadamia.edu.

It's been over five years since I finished my dissertation on unassisted birth in North America. I've been immersed in birthing and raising small children, teaching at a small liberal arts college, remodeling homes, and managing rental apartments. It's fun to remember what I used to think and write about night and day.

Ivy's crying...must go...hope I don't puke on her :)

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Tenure! (and something fun to read)

Eric just had his tenure review meeting yesterday...and he passed! We are so thankful for job security in this era of economic uncertainty.

Are any of you subscribers to the Journal of Perinatal Education? You might have seen Eric's essay "Freebirth" in the most recent issue (Volume 21, Number 4, 2012, pp. 202-205). It's worth the read :)
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God Was My Midwife: My Interview with Shifra Mincer

Last week, I spoke with Shifra Mincer, who runs the Jewish birth site Layda Birth. She had intended to interview me about my dissertation findings on unassisted birth, but our conversation soon took a more personal turn. We spoke about why I chose to give birth unassisted the first time--and why I did not for my subsequent two babies. We also discussed the LDS understanding of the Feminine Divine (a.k.a. Heavenly Mother) and how I found strength and wisdom from turning towards her in my first pregnancy. We ended with my thoughts on feminism's near silence on birth issues. If you're interested to read more, please read God Was My Midwife.

An excerpt:

A Mormon, Freeze has the practice of speaking to God directly through prayer and meditation. Mormons have the concept of God the Father and God the Mother, a kind of Godly husband and wife, she said.

When she was pregnant with her first child, Zari, Freeze said she found herself reaching out more than ever before the Divine Mother, asking her for guidance. “I did find myself, during my birth and pregnancy, connecting to my Heavenly Mother. I was like, okay Father, I need to talk to Mother." Then I would tell her, "I need your help and guidance, I need you to be there with me for this process. I need a female presence to guide me through this process.”

As she meditated and listened to hypnobirthing CD’s before the birth, a visualization kept coming to her: “My pregnant self was walking down this long hallway next to Heavenly Mother, this serene Mother who led me down to the room where I would give birth. There I had to do it myself. And then after I gave birth, I came out another door where I saw these crowds of women who had gone through this before.” Throughout the meditation she said felt a sense of real closeness with the Divine Mother and of “needing her with me. I really relied on that heavily during my first pregnancy.”

Read the rest here.

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Inga's birth story, part 1

I woke up to strong contractions around 1 am. From their length and intensity, I knew this was the real deal. I had to breathe slowly to work through them. Counting breaths became my early labor mantra. By the fifth breath, the peak would begin to subside. By the ninth or tenth breath, the contraction was gone. I got out of bed several times to use the bathroom and turn the water heater to the hottest setting, but otherwise made myself stay under the covers and rest. As much as I wanted to be up and moving with the contractions, I was too warm and cozy and tired.

I purposely didn't watch the clock, so I don't know how frequent the contractions were. But they were really intense. I listened to the Hypnobabies track "Easy First Stage" once. It was really relaxing and gave me welcome distraction from labor. I also composed a mental list of tasks for Eric to do in the morning: feed & dress the kids, drop them off at a friend's house, fill the birth pool, pick up toys, start a load of laundry, etc. Toward the end of the morning, I drifted in and out of sleep between contractions.

At 6:48 am, I got up to use the bathroom and decided that I had had enough. Time to get up and work with, rather than try to ignore, the contractions. I noticed the familiar pink-tinged mucous or "bloody show" that has heralded labor with all of my children. Soon we were all awake and getting ready. I called the midwife first thing to give her a heads-up, letting her know I'd call again when I was ready for her to come. I kept hurrying Eric and the kids on. Somehow I just knew that we didn't have the time for a leisurely morning. As soon as I got out of bed, the contractions starting coming much more frequently. I showered and dressed (bikini top & bottom, compression hose, yoga pants, & shirt) and started filling the birth pool as soon as the hot water tank had recharged. My logical brain was wondering if I was jumping the gun, but the instinctual part of me compelled me to act quickly.

By 8:15 am, Eric had returned from dropping the kids off. The pool was filling. From when I woke up until I got in the birth pool, I did "Rixa's labor hula" during contractions, as my sister-in-law calls it. This was right before I got in the pool and about 10 minutes before my body began pushing. You see me hit the button on the laptop when the contraction ends.



Eric hurried to finish last-minute tasks, then gave me a blessing. I've asked for one during each of my labors, and they have always been incredibly reassuring. By this point labor was really, really intense. I sensed the dizzy, spinny, buzzing feeling heralding the endorphins of advanced labor. But was I really that far along? I called the midwife a second time and told her to head over. I didn’t want her to arrive too early, but if my instincts were correct, things were really cooking.

I timed several contractions with Contraction Master. If this labor was anything like Dio's, I was getting close to the end based on how intense and how close together they were. These are the last contractions I had before I got into the birth pool (and in retrospect, about 30 minutes before the baby was born):

Somehow, I just knew that I would be pushing soon. There was no physical indicator, just an interior knowledge that the baby was on its way.

About 8:45 am, I got in the pool as it was finishing its final top-off. It was the perfect depth and temperature.

I was keen to film this birth, so Eric set up the video camera. I had a few contractions in the tub and started feeling a little bit pushy. Already? After another few contractions, in which you hear increasingly grunty vocalizations, there was no question. I knelt and reached inside. Sure enough, there was a hard round head about two knuckles deep. I felt around for a while, trying to figure out what was what. With all of the folded tissues and wrinkly baby’s head, it’s sometimes hard to tell where you end and baby begins!

Although the birth videos show only the physical side of giving birth to a baby, I was also going through an intense mental struggle. I knew that the sensations of pushing would only become more intense and more uncomfortable. Okay, let’s be honest: I knew it would hurt so much more than it already was. I dreaded it, yet I knew there was no escape. I’m not exactly fond of feeling a baby come out of my vagina, you know? It doesn’t feel good. First your butt feels like it’s going to split in half, then your vagina does. My vocalizations manifested this inner struggle, as well as the physical sensations going on in my body.

Like during Dio’s labor, I needed something to grab onto, so Eric and I “arm wrestled” during contractions. Once the baby’s head began to crown, I put my right hand down to support my tissues. I provided support against the perineum at first. Then, as the baby’s head emerged more and more, the burning and pressure moved towards the front. For the third time, I experienced the impossible-yet-inevitable sensation of a baby’s head emerging out of my body. My palm was cupped over the head. The baby was facing anterior, the smooth back of the head against my palm and my fingertips touching its face. There was a slight pause after the head was born. Then the shoulders emerged. I provided more counter-pressure in the front as the shoulders squeezed out. Another brief pause at the torso, one last little push, and the baby was born. I lifted it out of the water. We discovered we had a girl! We didn’t look at the clock until a few minutes after, so we’re guessing the baby was born at 9:12 am.

Soon after the birth, Inga lost muscle tone and color. I quickly realized that I needed to perform mouth-to-mouth. Fortunately, I became certified in neonatal resuscitation several years ago, so I knew what to do. It was tricky getting the angle right, since the cord was short. I gave her five breaths. After each breath, she coughed and perked up a bit more.

Within seconds of Inga being fully recovered, the midwife’s assistant arrived. I guess she hadn’t been debriefed about me wanting to be left undisturbed. She started bustling around and talking and asking questions and I got really annoyed. So I kicked her out of the room, saying, “I just need peace and quiet. I'm okay.” She beat a hasty retreat. This cracks me up.

One of my other favorite parts is in the middle of pushing when the phone rings and goes to the answering machine. It was an automated appointment reminder for my prenatal visit the next day!

I sat back in the tub for a few minutes to relax. It felt so good to be done!

Okay, now that you’ve read about the birth up to this point, go watch the videos. They're about 30 minutes total, from when I got into the tub until about 5 minutes after Inga was born. There’s some nudity since I don’t have a swimming suit bottom on, but it’s quite tame. Between the labor hula video and the birth video, you’ll get a really good idea of how I labor and birth. You’ll see me give birth in an upright kneeling position, provide my own perineal support and counter-pressure, catch my own baby, and narrate what’s going on. And you’ll get an earful of funky pushing noises!





Pretty intense, eh?

I rested for a few minutes, enjoying the warm water and weightlessness. The midwife arrived and helped me get settled into bed. Did I mention how good I felt? Ahhhh…I had a silky soft baby on my chest, I could finally lie on my back, and the hard work of labor was over. It felt glorious.

Inga started rooting around and pushing herself up with her feet. I wanted to let her do the breast crawl and self-attach. She started going through the breast crawl stages. But she got fussy and I was too impatient! So maybe 30 minutes after she was born, I gave her a little help and she latched on perfectly. The midwives and assistant stayed in the kitchen, entering the room only when I asked for something. It was a beautiful, quiet time spent snuggling and talking and resting.

I started feeling a bit grunty/pushy and figured it was time to get the placenta out. I called the midwife in. She held a bowl, caught the placenta, and then raved about how little blood I had lost—an estimated 10 cc (2 tsp) total! She took pictures of the birth pool and placenta bowl so that her colleagues would believe her.

About 2 hours after the birth, we did the newborn exam.

Then I showered and got my bottom half dressed. The midwife checked me for tears--just two periurethral skidmarks, so minor that they didn't even sting! Eric snuggled Inga skin-to-skin for a long time. It was fun to rest in bed together as a couple with our new baby.

After lunch, Eric brought the kids home to meet their new baby sister.



You might also want to read:
Inga's birth story, part 2
Part 3: Neonatal resuscitation
Part 4: Final reflections
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A butterfly birth

To end off the year, I wanted to share a lovely birth story from one of my blog readers, Brieanne. She lives in rural California, is LDS, and has three children. This was her second unassisted birth and third unassisted pregnancy. 

A few hours after Annelise's birth, once it was light enough to take a picture

I woke up on the morning of August 16 feeling a bit sad, as this was my daughter's fifth birthday. How time flies! This particular day I was also 12 days past my due date. This was not uncommon for me, as my first was 16 days late and my second was 17 days. We started the day by asking the birthday girl what she would like me to cook for her birthday dinner. She said she wanted a roasted chicken and potatoes, with loads of gravy, and an apple crisp.

After I made my shopping list we all packed into the truck and went to the chiropractor for my bi-monthly adjustment. The chiro made a comment that he would "help me get things started." In my head I thought it was cute he could think he would make any of my babies be born if they weren't ready. Not in this family! I thanked him and told him I hoped I would not be back in two weeks. He agreed.

Our next stop was the grocery store. I picked up all the ingredients to make my daughter's dinner, and then we came home. I put groceries away and then Eric and I sat down to place our food co-op order. Eric was annoying me by opening every page of the website to look at every single item. I had a weird sense of urgency, but was having a hard time relaying this to him without thinking I would hurt his feelings. I finally went outside to call our landlord to see if I could borrow her oven to roast a chicken. She said it was fine, although it was over 100 degrees that day and would make her kitchen hot. I told her I would be up in a bit.

Once I gathered up my items we all piled in the truck again and drove the minute to her house. I preheated the oven, and started prepping things. As she and I were discussing the birth, I felt a click in my uterus and felt a trickle down my leg. I looked down at the white floor and noticed whatever came out of me was yellow. I am sure my face flushed red because for a second I thought I peed on myself. I must have gasped because she asked me what was wrong and I told her that I thought my water broke. We both went to the bathroom and I took off my pants and sniffed, but there was no odor. I knew then it must have been amniotic fluid.

Eric was upstairs fixing a toilet for the landlord, and just as I came out of the bathroom he was coming down the stairs. I told him my water broke, and he smiled really big and looked very happy. I told him I needed help because I anticipated a fast birth, and he agreed. Once we started cooking I had an enormous contraction, which was about 45 minutes later. The time was 7:45 at this point. I knew I had better get down to the house and start preparing for a baby, since my last birth was only 3 hours. We got everything in the oven and then Eric took the kids and I back to the house. He told the landlord he would come and get the food when his phone timer went off.

Back at our house I cleaned up the yard, had Eric set up my tent as this was an outside birth, and got blankets and my birth basket in the tent. At one point I looked out and saw my kids helping Eric put up the tent, and realized what a beautiful picture it was of the whole family helping prepare for our new baby. My daughter then came in and asked if I had put on my blessingway beads yet. I thanked her for reminding me, and then went to put them on. While I was placing them around my neck I dropped one side of the string and all the beads slipped off. My 3 year old scrambled around picking up each bead and then carefully placed each one in my hand with his chubby little fingers. I will never forget this little detail in all my life. It was so symbolic! Here is my former baby helping me prepare for the new one. It brings tears to my eyes every time I think of it.

It was around this time my contractions were pretty steady, but were not very painful nor did they require my attention. Eric left to get our food, and when he came back I fed everybody. After dinner we all gathered around holding hands while Eric gave me a blessing. I felt the Holy Spirit telling me all would be beautiful, and not to worry one bit. During my pregnancy I had butterflies follow me around whenever I thought about the upcoming birth. It started when there were 3 in my blessingway tent just weeks before, and then almost every day after, up until the birth. My husband's grandma even called one day to tell me a butterfly was following her around, and it made her think of me and the birth. She had known nothing of my similar experience prior to calling me. I could see my Heavenly Father's hand in all of this, and I was so at peace during the Priesthood blessing.

After the blessing I laid in bed with the kids and attempted to read them a book, but the contractions got too strong and I had to let Eric take over. After the kids fell asleep I stood in the front doorway looking out and my contractions got really strong and regular. I decided at this point to go outside in the tent. It was a beautiful summer night. The weather was really warm and the owls were flying around, like grey ghosts in the sky. We live on 22 acres, in a pretty rural part of California. Going outside was making the decision to join nature in something only nature does the best: giving birth. At this point I let go of all tension and entered my tent. This was a kitchen tent, which was just screen on all four corners, that zipped up so that flies and mosquitoes couldn't get in. Eric was in the shower, so I labored all alone for about 20 minutes. I really got into the flow of labor while he was gone, so when he came in the tent to tell me he was coming in and to ask if I wanted a chair, I felt a bit disturbed. I agreed to the chair, but couldn't bear to tell him I didn't want him coming into my space. When he came in he set my chair in front of me with a towel on the seat, to put my head on, I was on my knees so this was perfect for me. He then set his chair in a corner and just sat there, silent as a mouse. I could see him in the moonlight, and he looked so peaceful there, just watching me. I decided then it didn't bother me too much. Every time I focused on breathing through a contraction, I would look up and see exactly half a moon in the sky, and and then feel so centered.

After doing some pretty hefty labor dancing, I got back on my hands and knees and started pushing. I didn't feel "pushy" at all, but something deep inside told me to just push. When I did I felt the baby come down and then felt pushy. I ripped my shirt off and announced I was hot, so Eric grabbed a book out of my birth basket and started fanning me. I heard a pack of coyotes all howl in unison, and I felt so in touch with myself and with my Heavenly Father's creations. Finally I felt her head crowning, and after screaming at the top of my lungs into a towel, I lifted up one leg and our baby slipped out. The time was 12:41 am. Oh how easily I forget how painful the crowning part is!

Since Eric had made the decision to fan me instead of catching the baby, it gently unfolded onto the blanket. We had only the light of the moon by which to see, so when I turned around to pick up the baby, I swept my hand over it's bottom and didn't feel some parts I expected to feel, since I thought for sure it was another boy. I told Eric she was a girl, and he said he had known all along. I held her close expecting to hear her cry, but she just kind of made some little tiny noises. I felt in the dark and realized the cord was wrapped around her neck, so I gently unwrapped it. She then let out a tiny cry, but not much more than before. She was perfect in every way, but just didn't feel like crying I guess. In the moonlight I could see she looked exactly like my daughter! She was also born 41 minutes after her birthday.

About a minute after she came out, I felt what I thought was the placenta come sliding out, so I immediately wondered why the placenta came out so fast. I had Eric get his headlamp and shine it on the mass. It turned out to be a huge bunch of blood clots! I was confused about this part, but obviously we were both fine, so I didn't worry. I am still a bit curious to know exactly what these were and why they were so big. I didn't experience this with my previous births. About 20 minutes later I tried to push out the placenta, but it only partly came out, so I left it alone for a bit longer.

The baby started to vigorously suck her fist, so I nursed her thinking I would take a shower when she was through, but every time I tried to unlatch her to quickly clean myself off, she would start crying. I ended up sitting there cross-legged, nursing her in the dark, for almost three hours straight! Finally she was through, and so I had Eric cut the cord and pushed out the rest of the placenta. I "rushed" to the shower inside to get clean, and then got dressed and took the baby. All this time the kids had been asleep, so it was actually pretty romantic spending time with my husband, and now just the three of us.

After a few days we decided to name her Annelise Farfalla. Farfalla means "butterfly" in Italian. I want her to always remember how much her Heavenly Father watched over the two of us on our journey through the pregnancy, and then the birth, and how spiritual and wonderful her birth was.

Annelise with her two siblings

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How to watch "Le Premier Cri"

Almost 3 years ago, the film Le Premier Cri was released. I've been eager to watch it, but it never came to any local theaters, nor has it been released on DVD in North America. When I was in France this summer, I finally decided to buy a copy. The region coding won't play over here, but I decided that I'd find a way to make it work. Somehow.

Tonight, I came across a brilliant solution: recode my DVD player to become region-free! It took about 30 seconds. I googled the name and model number of my DVD player, along with the words "region free code."

I watched the first 15 minutes of the film and had to tear myself away to get ready for bed.

If you read the comments to this post, you'll hear from several people involved with the making of the film, as well as some of my own translations. I've also translated information provided on the film's website about Vanessa, the Canadian woman who had an unassisted birth, here.

To purchase a copy, visit Amazon France. It costs 10 Euros plus shipping.


I can't wait to watch the rest tomorrow!

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DIY Medicine: From Blogger to YouTube

A few years ago, I mentioned an article from the Ottawa Citizen called Barbarians in Blogistan, which discussed the new do-it-yourself movement spreading via blogs. Today, the newest repository of self-help medical knowledge--to be shunned if you have any common sense, the article implies--is YouTube. In DIY Medicine, Dakshana Bascaramurty of the Globe and Mail argues that the new frontier is no longer online medical diagnosis--it's YouTube.

Before, doctors worried about patients who self-diagnosed after doing Internet research on questionable medical websites. But the social Web has given birth to a new beast: users who document their DIY medical procedures on camera and share the videos on YouTube.

Among the procedures mentioned in the article are toenail removals, cyst excisions, boil lancing, cast removal, suture or staple removals, abscess drainage and tattoo removals. And, of course, unassisted birth. Most of the article's examples contain some grisly language describing people pulling out their own toenails, or removing surgical staples in the backyard after a couple of beers. But unassisted birth has, by far, the strongest cautionary tale. The author mentions a 14-year-old girl who gave birth unassisted to a baby who died shortly after birth and threw the baby in a dumpster. Here's an excerpt:

Particularly troubling to Richard Musto, a public health physician with Alberta Health Services in Calgary, are the videos that depict unassisted home births, some of which have garnered millions of hits and several comments from expectant mothers eager to learn about the procedure.

Last month, a 14-year-old girl in Texas was charged in relation to the death of her newborn boy, whom she left in a dumpster. The baby died minutes after he was born and investigators suggest it may have been because the afterbirth blocked his airway. The girl and her younger sister learned how to deliver the baby at home after watching videos on YouTube.

“You can understand it’s a natural thing, but things go wrong in childbirth and that’s why you need to have someone that’s properly trained to manage that,” Dr. Musto says.

I get tired of childbirth being lumped together with medical procedures--from brain surgery to cyst removal to dental surgery. I also find the example of the teenager who throws her baby in a dumpster incredibly insulting to the vast majority of women who prepare extensively for an unassisted birth. Sure, I do worry about someone giving birth unassisted after watching a few videos and reading a some online articles. But that is not reflective of most UCers' level of preparation.

For example, before I gave birth the first time, I became certified in neonatal resuscitation and had first-hand experience resuscitating a newborn. (Short version of the story: precipitous birth, terrible Midwest blizzard, midwife driving as fast as she could. Baby came out limp and unresponsive to stimulation. Midwife was on the phone, advised mouth-to-mouth. The baby perked up after a few minutes of M2M. Midwife arrived a few minutes after the birth, by which time baby was stable and crying. I had vernix all over my face and glasses and clothes. It was quite the sight.)

I'm not saying unassisted birth is perfectly safe, just think happy thoughts and nothing will ever go wrong, la la la. But condemning all unassisted birth--childbirth, after all, is a normal, inevitable physiological event, not a medical procedure--because of one tragic "dumpster baby" is way off the mark.

I'm not calling this one Code Mec yet. But it definitely merits an emphatic eye roll.

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Thoughts about unassisted birth: part II

If you had the time to read back through the selected posts listed in part I, you might have noticed a gradual shift in tone. During Zari's pregnancy and immediately after her birth, I was on my "honeymoon" phase in my relationship with unassisted birth: a bit idealistic, breathlessly in love with the idea of undisturbed birth as the pinnacle of the birth experience, enraptured and fascinated with the practice. Now, it was still me writing, which means that my pragmatic and analytical selves were still present even when I was strongly advocating unassisted birth. But compared to how I feel now, after a second pregnancy and birth, I would say that my relationship with unassisted birth has settled into a more mature, complex, and nuanced pattern.

Towards the end of writing my dissertation about unassisted birth, I was already finding myself critical of certain trends I saw emerging in online UC communities--the trend toward dogmatism, the distrust or even demonization of midwifery, the embracing of slogans (trust birth! breech is just a variation of normal! etc.) that mask the complexity of reality. In particular, the abandonment of education and preparation--and of midwives--in favor of "trusting my body/following my intuition."

Here's an excerpt from my dissertation on this topic (from chapter 4):

After years of immersion in UC communities, I have started to notice a trend toward dismissing the necessity of knowledge and preparation, toward emphasizing intuition to the exclusion of almost anything else....I am not sure if this anti-education and risk-denying undercurrent has always existed and just I never noticed until now, or if it really is a new development. This tendency is not universal, but it is prevalent enough that others besides me have noticed it....

Over-reliance on any one type of knowledge can be dangerous. No one source of knowledge about birth is infallible or complete. Even if intuition is believed to be inherently accurate, it is not omniscient or omnipresent. UCers and midwives have separate sets of challenges regarding intuition. As Lucia Roncalli noted, midwives need to incorporate intuition into their clinical training and experience and give it adequate respect. For UCers, the challenges are to sufficiently refine one’s intuitive skills and to balance education and preparation with a trust in intuition. This is a difficult process—walking the knife’s edge of embracing intuition as a “knowledge that matters” without falling into the trap of intuition becoming “the only knowledge that matters.”

To be fair, I wonder if some of the things I'm perceiving is just that--a problem of perception. Since I finished my dissertation, I haven't followed online UC communities as closely as I used to. I'm more of a casual browser/eavesdropper now, rather than regular reader and participant. I know that just dropping in on certain messages might not give me the full context of the larger discussion--just as overhearing bits of a conversation is not the same as participating in it from start to finish. Knowing the full context really does make a difference.

What I am not doing in this post is disavowing unassisted birth. I am just trying to explain that I feel many different ways towards the idea all at the same time. I do feel less comfortable "promoting" UC than I used to. If a woman hires a midwife or a physician, she can shirk the responsibility of education and preparation, and things will probably be okay--in a "everyone comes out alive and relatively healthy" sense--because there is someone else there with extensive knowledge and training and skills to fill the gap (even if we might debate the usefulness of, say, surgical skills for a normal vaginal birth). But with UC, all of the weight is on you and you alone. There's no one else to catch you if you stumble.

I am reminded of one of my favorite professors: ethnobotanist Dr. Paul Cox. He served an LDS mission in Samoa, and his approach when teaching people interested in his church was to talk them out of joining. He wanted them to be 100% sure that they were joining because they had a personal testimony and unwavering belief. If he couldn't talk them out of it, he knew they were really serious. I feel the same way about UC. I think giving birth unassisted is wonderful--but I don't want to talk anyone into it. I don't want to over-romanticize it, or promise women a pain-free ecstatic birth if they just get rid of the midwife/their fears/their doctor/the hospital. I want women to have an undeniable inner knowing that an unassisted birth is right for this baby, this pregnancy. And to have the concomitant desire to do the necessary preparation for giving birth without a care provider present.

I absolutely stand by my decision to give birth to Zari unassisted, just as I do my midwife-attended birth with Dio. If anything, both experiences have taught me to trust that inner voice--call it intuition, divine/spiritual guidance, whatever you like--no matter where it takes me. It might sound airy-fairy for some readers, but nevertheless it was undeniably real for me in both pregnancies. I hope I never need to give birth in a hospital, but if I do feel drawn towards that for a future pregnancy, I hope I can embrace that guidance and move forward with confidence.

If I didn't feel strongly guided one way or another, I'd probably hire the same midwife if I became pregnant again. I really enjoyed our prenatal visits. Her presence at Dio's birth didn't disturb me or interfere with the birth in the least--of course it helps that she arrived only 30 minutes before he was born! And I do like having someone with extensive knowledge and skills that I can call upon. I would not have access to that where I live if I were planning an unassisted birth and doing my own prenatal care. But I also recognize that my unassisted birth with Zari played a huge role in knowing what I wanted from a midwife and in knowing how I labor and birth. If anything, that first unassisted birth gave me more confidence in myself to be able to labor successfully in many different settings.

Stay tuned for part III, in which I respond specifically to Barb Herrera's post The UC Oxymoron.

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Thoughts about unassisted birth: part I

Barb Herrera's recent post, The UC Oxymoron, got me thinking about my own perspectives on unassisted birth and how they have changed since I first encountered the idea.

First, a selection of posts relating to unassisted birth, in chronological order

Pregnant with Zari:
Prenatal care
Better is not good enough
Naming my fears
Pushed and pulled
Zari's birth story

After Zari's birth:
Some reflections
Wish-I-had and glad-I-did
First impressions
I am selfish
Barbarians in Blogistan
Reuters article on Freebirthing
Formative words
If I were looking for a midwife
Vision of Unity

Pregnant with Dio:
Birth plans
Working through some conflicted feelings
The root of my worries
Just birth
Musings on breech
Belly shot: 30 weeks pregnant
Belly shot: 33 weeks pregnant
Not staying true to my word...whatever that means
Midwife's role at my birth
From UC to a midwife
Dio's birth story and pictures

After Dio's birth
My image of birth: before

My image of birth: after
Thinking, no conclusions yet

Stay tuned for part II, in which I will discuss my current perspective on unassisted birth.

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How many midwives...?

...does it take to change a lightbulb?

None, according to Erik Lee in Bossy Midwives. Sometimes we just need to lighten up a bit when we talk about birth. I think you'll enjoy his thoughts. A teaser:

An anesthesiologist, an OB, and a midwife walked into a bar. The anesthesiologist ordered a pitcher of stout and a double burger; the OB ordered a Reuben and a bottle of red wine; the midwife ordered their biggest plate of steak and fries with a margarita. They all sat in a booth and shared war stories.

A long time passed, and the three realized something had gone wrong with their order. They decided to find out what the problem was. They found the busboy just behind the swinging double doors to the kitchen. He was struggling to get their overloaded cart from the tiled kitchen to the carpeted dining area. The wheels kept catching on the bump.

The anesthesiologist kneeled down and examined the tires. “You just need to inject something here in the back,” he announced. “Then everything will go better.”

The OB leaned down to look at the carpet. “This part of the carpet is blocking the cart,” he announced. “Give me a knife and I’ll just give it a little cut to help it along.”

The midwife leaned over to the busboy and whispered loudly in his ear, “You can do this! Just PUSH!”

Read the rest here.

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Birth Photography

I occasionally come across birth photography that takes my breath away. I am not able to embed the first one, so be sure to watch The Birth of Amerlyn Grace on the photographer's own website, Life in Motion. When I watched this slideshow, I had a visceral memory of my own labor and birth--leaning over a table, rocking my hips and swaying my head slowly, totally engulfed in the sensations. The pain inscribed low on my belly. The rhythmic, slow breaths, each one bringing me closer to release. The headiness of the birth endorphins making the room seem to sway and shift.

The second one by Lynsey Stone Birth Photography shows an unassisted birth.


Both videos are child- and work-appropriate. And, darn it, they make me want to do it all over again!

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Not staying true to my word…whatever that means

In the past few days a reader posted the following comment:

why are you using a medwife? I was a little disappointed in you for not UCing, and now it's like wow you must not really stay true to your word.

She also emailed me this message:

Are CPM's illegal in your state if not why are you [not] using one? CNM's are really dangerous and I thought every unassisted birther knows this. They are more like medwives which to me would be way too scary. So why are you using one?

I would like to respond to these two comments. I am trying really hard to keep my tone restrained. Believe me, you don’t want to fall on the wrong side of someone who taught university-level rhetoric. So pardon me if I come off a bit strong at times.

Overall, these comments epitomize dogmatism and fanaticism at their worst—blind adherence to a belief system, inability to see beyond a narrow worldview, lack of experience with the messiness and subtleties of real life (or should I say real birth?), a black-and-white perspective in which choices are either absolutely Right or Wrong regardless of context, and gross generalizations.

Now, onto some particulars:

The “medwife” comments
Without having ever met the midwife I am seeing, the poster makes sweeping assumptions about her practice style and philosophy of care, simply because of the initials behind her name. I have worked with and know both direct-entry and nurse-midwives, and I have learned that you cannot assume anything about their style of practice from their educational background. To automatically label any CNM a “medwife” (a term used disparagingly to indicate a midwife who acts more like an OB than a midwife, in other words someone who is very medically/technocratically oriented) is not only insulting to the many CNMs who are very holistically minded, it also functions as a red herring, diverting attention away from important issues. We’re not going to move forward in our effort to improve birth culture and practices if we throw around pejorative terms like these.

For an interesting examination of the ideological conflicts (perceived or real) between DEMs and CNMs, I suggest reading Mainstreaming Midwives: The Politics of Change, edited by Robbie Davis-Floyd. It is true that there is, at times, an ideological divide between DEMs and CNMs. Davis-Floyd includes these two quotes in her introduction:

CNMs think DEMs have copped out, and DEMs think CNMs have sold out.
Joyce Roberts, President of the American College of Nurse-Midwives, 1999

One group needs to tighten up, and the other group needs to lighten up!
Katherine Comancho Carr, President of the American College of Nurse-Midwives, 2005

“I was a little disappointed in you for not UCing”
I’m always a bit surprised to hear people tell me this. These comments imply that other birth choices are somehow inferior, less worthy of admiration, or indicative of weakness or lack of principle. If anyone is going to be disappointed in my birth choices, it should be me and me alone. If having an unassisted birth is right for one birth but not for another, then why should anyone be disappointed? Is there some hidden contest I’m supposed to be participating in, some Uber-Alternative-Mama medal I’m supposed to be aiming towards?

Now, this doesn’t mean that I am abandoning unassisted birth in principle or even in practice. To be more precise, my seeing a midwife this pregnancy, or my having an unassisted birth last time, goes no further than myself and my own experiences. I don’t uphold any one path to giving birth as The Only Right Way To Have A Baby. I do believe strongly in undisturbed birth, in supporting and facilitating the physiological and hormonal process whenever possible, and in gentle and empowering births that bring health and healing to mothers and babies. So yes, I do think that our national cesarean rate is atrocious, that far too many mothers and babies come out wounded and shell-shocked from their births, and that we have a lot of changes to make in both hospital and home birth culture. But I don’t for a minute believe that UC is more “pure” than having a midwife, which in turn is supposedly “better” than a birth center, which is of course preferable to a CNM-attended hospital birth. And don’t even mention those awful OBs who just want to slice & dice women, who only care about getting home for dinner…

So let’s please get beyond these trite beliefs and assumptions. I understand why some readers might be curious about why I am seeing a midwife this time, and I am more than happy to enter into a dialogue about that. But I am surprised at the inference that my actions during this pregnancy constitute a betrayal (of what? I’m not sure) or that I am “not staying true to my word.” I never remember making a vow to have unassisted births for the rest of my reproductive life. (Now granted, if I felt it was right for each pregnancy, I would gladly do so!) Did I miss something here?

I will be honest and admit that I do have some trepidations about having a midwife present. I think with any birth choice there are unknowns that can bring worry or doubt. During Zari’s pregnancy, I had moments when I wondered if I was really making the right choice, wanting to be sure my personal preferences weren’t getting in the way of what was best for me and the baby. This time around, as I have mentioned in other blog posts, I have wondered how I will be able to balance my need for privacy and autonomy with my desire to have a midwife present for her emergency skills & knowledge. I don’t know if there’s ever a perfect balance to these sometimes conflicting, sometimes converging, needs. Last time, I knew clearly that I needed to do it alone. This time, I feel more strongly the need for additional options and resources, even as I wonder if or how the midwife's presence might alter my ability to labor. Still, I feel good about continuing along the path I have chosen. A lot depends on what happens as labor unfolds—will I call her early? late? will my birth unfold quickly enough that she arrives after the fact? I don’t know—I can only say that I will be closely following the intuitive and spiritual promptings that guided me strongly and clearly during Zari’s birth. If I do that, then there is no room for doubt.

To conclude this post, I wanted to include a recent comment from another reader, Irene, in the hopes that I have answered her questions and concerns adequately. She has identified the core tensions that I, and many other women, experience between privacy, autonomy, and security. After reading my post about working through some conflicted feelings, she wrote:

Hi Rixa, I just breathed a huge sigh of relief. At first your choice in having a midwife this time around alarmed me, I even felt somewhat confused and betrayed as I saw you as such a wonderful spokesperson for UC moms. But as I read this last blog, I realized that pregnancy and birth are so personal and intimate it is so difficult to make the choices we make. I truly hope you have the birth you desire and that your baby is healthy and that you are happy…

For myself, the only reason I would want a midwife around would be for the afterbirth--in case of an emergency situation and to help with the cleanup but the pros are pretty even with the cons as my need for privacy and birthing alone would definitely result in more complications. (I learned that with my first birth too, even having hubby in the room slowed my labor a lot, I really needed to be alone). So I think that for myself, having a midwife around would ease some concerns but ironically open up Pandora's box to a slew of new concerns and perhaps complications that could have otherwise have been avoided.

Thanks so much for your blog. I am sorry that I at first somehow felt betrayed by your desire to have a midwife; I guess you made me second question UC but after reading this blog (I do check your blog but not too frequently so I missed this one at first, stating your reasons for wanting a midwife), I realized just what a tough position you are in. In a way I think you are looking for what we all want—privacy & autonomy, but a midwife would provide the added benefit of security. Ironically, a midwife would also take away some of the privacy and autonomy so really it is such a tough call.

I look forward to reading your birth story.

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My brother rocks

A few weeks ago my little brother (well, at 21 years old and 6 feet tall, he's not really so little) wrote me this quick note from Russia. He's currently serving a mission for our church in Vladivostok, Russia. Some translations of LDS lingo:
sister = female missionary, usually ages 21-23
elder = male missionary, usually ages 19-21
senior missionaries = usually retired couples

There is one sister that loves that you gave birth at home, you breastfeed, and that Zari breastfeeds her stuffed animals. Also, I brought up the whole birth thing with the senior missionaries with us (around the dinner table at a restaurant), and they were all weird about it, but I loved it--they were so shocked, but I was thinking the whole time, "If you want shocked, I could tell you about the placenta, or the various uses of garlic*." Then some other elders were talking about how they will force their wives to give birth at a hospital, because they "don't want to take any chances," but I turned that one down. It's true--people treat birth as something inherently wrong, that it should be medically treated. True, there are other options other than unassisted at home (Joss [my younger sister], in a hospital birthing center). So I was telling them all about it, even though I'm male, will never have birth, and still am single.

He is hoping to go into radiology, so he should have lots of opportunities to talk about birth & breastfeeding when he's in medical school. I love that he occasionally uses Russian-isms when he's writing in English ("will never have birth," for example). My brother is awesome!

* Referring to its use for treating yeast infections--my family just can't get over how weird they think this is, so it's become a family joke

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News, research, and more

It's time to clean out my files and bookmarks again.

Are antibiotics beneficial for preterm labor or PPROM?
Preterm Abx beneficial for PPROM, but not for preterm labor. A newly published meta-analysis has concluded that antibiotic use prolongs pregnancy and reduces neonatal morbidity in women with preterm premature rupture of membranes (PPROM) at a gestation of 34 weeks or less. The same analysis found little evidence, however, of a benefit from using antibiotics in preterm labor occurring at 34 weeks or less. Source: American Journal of Obstetrics & Gynecology 2008;199:620e1-e.

Is Acupuncture Effective at Inducing Labor?
Acupuncture to induce labor: a randomized controlled trial.
Obstet Gynecol. 2008 Nov;112(5):1067-74.
For women with a scheduled postterm induction, acupuncture sessions before the induction did not reduce the need for inductions or the length of labor. This trial used sham acupuncture, which is a great way to lessen the placebo effect of acupuncture. The conclusion from the abstract: "Two sessions of manual acupuncture, using local and distal acupuncture points, administered 2 days before a scheduled induction of labor did not reduce the need for induction methods or the duration of labor for women with a postterm pregnancy."

Precipitous births in the news:

• A UK mum gives birth in an ambulance outside restaurant. She had planned a home birth, but decided to transfer when the baby unexpectedly presented breech. On the way to the hospital, the baby flipped back to vertex and was born en route.
• Baby boy arrives on bathroom floor. The couple was planning a home birth anyway; the midwife dind't arrive on time. So dramatic! How amazing that the mother and father managed to deliver their own baby!
• A Denver woman riding a city bus goes into labor and has the baby in a public library.

Other birth-related news and articles:

• Erykah Badu gives birth at home to a girl
• Routine epidural turns deadly (this is an older article but I am trying to clear out all my extra bookmarks).
• Call for Abstracts for the Australian College of Midwives 16th Biennial Conference: "Midwives & Women: A Brilliant Blend" is being held at the Adelaide Convention Centre, from the 22 - 25 September 2009. I wish I could go!Any way I could get funding for this?
  
• Home Delivery: The Movie. From the website: "This film documents the lives of three women in New York, who for very different reasons have decided to go up against social trends and take the birth of their children into their own hands… and homes." I haven't seen this one yet. It's available for purchase here.
• BirthLove is back (don't know how long, though) on this website!
• Woman to Woman Childbirth Education shares her thoughts about the UK documentary on Freebirthing. She argues that "if doctors or midwives want to stop [unassisted births], they have two choices — scare women out of doing it, or make the alternatives more appealing."
• The Independent Childbirth blog examines Why American Women Can't Handle Labor (or why people think they can't).
• The Times (UK) discusses how pregnant women are "risk magnets." Vivienne Parry writes:

  Pregnant women are risk magnets, attracting every sort of scare about potential damage to their babies at a time of their lives when they are most fearful, for themselves and for the new life they carry. Not only are food scares (too much liver, too much fish, etc) aimed squarely at mums-to-be, but there are also horror stories about the maternity services. The irony is that the perception of risks may be more harmful than the actual risks.
  

Sewing/crafting:

• Babywearing Coat Instructions: this tutorial shows you how to alter a normal jacket or winter coat into a babywearing coat. A great project to try with a secondhand coat! I'll have to make one of these for next winter.
• CPSC grants one-year reprieve for certain products. This news has handcrafters relieved, as many were worried they'd have to shut down because of the prohibitive costs of lead & phalate testing. Forbes op-ed piece on the CPSC law (written before the reprieve was announced).

Ecological/sustainable living:

• How Women Can Bleed Green: an article about reusable menstrual products

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Just birth

This is a lovely birth video. I call it the "anti-Hollywood" birth scene. It shows a laboring woman and occasionally her husband. She labors and grunts and moans a bit and then she has a baby. Wow! Who knew it could be so simple? I like seeing birth videos that show the essence of giving birth--not the machinery, not the procedures, not the attendants, but just the woman working with her body to bring forth a baby.



I think that was the most valuable part of The Business of Being Born: seeing so many women simply give birth. (Now there was more busy-ness with some of the births than I would have liked; Cara is too hands-on and chatty for my own preferences, but I digress.) I think my favorite birth in that movie was the hospital birth center birth, where the woman in the minidress has her baby standing up.

At its core, birth is so simple and yet such a mystery.

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The root of my worries

I've been corresponding with my friend Jenne from Descent into Motherhood about my desires for this upcoming birth. We are both seeing a midwife and trying to decide what role we wish them to play in our upcoming births. She wrote to me yesterday something that perfectly sums up the root of my concerns:

Have you thought of it as a control issue? You have had an experience where you were totally in control, autonomous, and making your own decisions. And now it sounds with this particular midwife, you are going to have to give some of that decision making power to her because there will be things that she may not budge on. It's important to you that you are alone in the room, and she may not allow that to happen. Not only does that feel like your power is being taken from you, you may fear that her presence will alter your ability to birth in some way. I think I'm projecting my feelings on to you but I know that it's that reason that I would be uncomfortable with having a midwife. Maybe it's just what you've described to me about this particular midwife. Tell me if I'm wrong on that and I'll be quiet. My fears with having a midwife present are two-fold: I don't trust her to not take control of a situation in a way that overrides my autonomy. That of course is at the root of what I didn't like about my birth experience with my son and led me to consider a UC. I hated having to fight for the responsibility to make my own choices when I could choose to not have to face that fight at all.

My core concerns center on autonomy and control--not control of the birth process itself, but control of my surroundings and those people around me. It's important that I can totally relax during labor and not worry about any externals. For me, I accomplish that through careful planning and control over my birth environment. In a way, I seek to control some things before labor so that I can give up control when labor begins.

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Working through some conflicted feelings

This pregnancy has been marked by a series of conflicting feelings about what I want for the birth. Zari’s unassisted birth was fantastic and really could not have been improved upon. I also felt strongly drawn to having an unassisted pregnancy and birth with her. While I of course had some doubts, fears, and hesitations along the way—doesn’t every pregnant woman at some point?—I just knew that an unassisted birth was what was right, what I needed to go through.

When I was a graduate student in Iowa and trying to conceive my first child, I was working as a doula and apprenticing with a direct-entry midwife. After we moved to Illinois, I started assisting a home birth CNM at prenatal visits and births occurring in my area. This pregnancy, I am living in a new state and for the first time in several years, I am not a part of the local midwifery community. This is part of the reason that I felt the need to initiate care with a home birth midwife here; I no longer had access to midwifery care, advice, or skills except through a formal, paying midwife-client relationship. There are a few things that I want access to: during pregnancy, I like checking my hemoglobin levels early in pregnancy and again around 28 weeks to be sure that my blood volume has expanded adequately (hemoglobin levels should drop by the 28-week check; if they are stable or rising, that is cause for concern). I want someone to check me for tears after the birth, suture/Dermabond if necessary, and to do bloodwork in case I want a Rhogam shot. While I could in theory go to a hospital for those postpartum services, it would be extremely disruptive and kind of pointless to get in the car hours after having a home birth!

I also find myself wanting the option of having skilled assistance during labor for certain rare emergency situations: shoulder dystocia primarily, and to a lesser degree rapid postpartum hemorrhage or the baby needing resuscitation (the latter is the least worrisome to me, even though it is probably the most common of the three scenarios I listed, since I am trained in neonatal resuscitation). This wasn’t as much of a concern during my first pregnancy, but I find it weighing more heavily on my mind this time. I suspect it’s because, now that I have a child of my own, the idea of losing a baby is no longer an abstraction to me. I wouldn’t say at all that I was simply being callous or naïve the first time around, just that the possibility of losing a child is more palpable to me now.

I was happy to learn that a home birth midwife lived only 20 miles away from our new house—the closest I have ever lived to a home birth provider in many years. Although I could pay out-of-pocket for a midwife, I was quite happy to find that she was a CNM who could accept my insurance. This means that instead of paying $3,600 for her global fee, my out-of-pocket expenses are around $1,000 ($500 for the deductible and another $500 for the 20% co-pay). Labwork and birth pool rental are additional; she rents out heated, jetted Spa-In-A-Box pools, but I won’t need that now that I have a free La Bassine.

I met with the midwife early on in my pregnancy to talk about what I was looking for and figure out if she would work for me. I talked about my first birth and how I was looking for a hands-off midwife who would respect my need for privacy. I had a few specifics I quizzed her about: was she willing to not listen to heart tones at all? (No; she’d like to listen every 30 minutes. But otherwise she is fine staying out of the room while I am laboring.) Was she willing to stay in another room during the actual birth? (No, she’d prefer to be in the room as the baby is being born to keep an eye on possible problems). I am actually quite fine with having heart tones checked. I understand from a midwife’s perspective why it is important to listen. If I am inviting a midwife to the birth, she does need to have a way to know if the baby is responding well to labor.

The second point is more of a stickler for me, and it’s been on my mind a lot recently. I feel very strongly about keeping the “birth bubble” intact in the immediate postpartum period. Even many home birth midwives tend to do a lot of stuff right after the birth: putting a hat on the baby, rubbing it gently with towels, speaking with the mother, suctioning the baby’s nose and mouth, taking a full set of vitals every few minutes (baby’s heart rate & respiration rate, mom’s blood pressure, etc), feeling if the placenta has detached, etc. While these activities are not terribly interventive in the grand scheme of things—after all, baby is usually still in the mother’s arms—they do “wake the mother” and take her away from that critical time in which her primary task, physiologically speaking, is to produce high levels of oxytocin to help the uterus clamp down efficiently, the placenta to detach cleanly and completely, and thus prevent a postpartum hemorrhage. In Michel Odent’s article “The First Hour Following Birth: Don’t Wake the Mother!”, he explains how midwives ought to behave in the immediate postpartum period:

They first make sure the room is warm enough. During the third stage women never complain that it is too hot. If they are shivering, it means the place is not warm enough. In the case of a homebirth, the only important tool to prepare is a transportable heater that can be plugged in any place and at any time and can be used to warm blankets or towels. Their other goal is to make sure the mother is not distracted at all while looking at the baby’s eyes and feeling contact with the baby’s skin. There are countless avoidable ways of distracting mother and baby at that stage. The mother can be distracted because she feels observed or guided, because somebody is talking, because the birth attendant wants to cut the cord before the delivery of the placenta, because the telephone rings, or because a light is suddenly switched on, etc. At that stage, after a birth in physiological conditions, the mother is still in a particular state of consciousness, as if "on another planet." Her neocortex is still more or less at rest. The watchword should be, "Don’t wake up the mother!"

Pamela Hines-Powell has written about this as well (and I interviewed her more in depth about what she does/does not do at births for my dissertation). Immediately postpartum, her default routine—what she does unless the mother requests otherwise—is to stay silent, out of the mother’s line of vision, and quietly observe the mother and baby from several feet away. No one but the parents touches the baby for the first hour or so after the birth. The midwives only step in to assist or interact once the mother initiates contact (barring, of course, an emergency situation). For example, here are a few of her common birth & postpartum practices, taken from a longer post about her midwife identity crisis:

• Routine vaginal exams - during labor or prenatally. It’s not uncommon for us to never touch a woman’s vagina - or even see her vulva - until the baby is crowning (if we can see it) or afterwards when looking for tears/lacerations.
• I’m not going to do perineal massage or even support of the perineum (some women with land births like to have some rectal counterpressure) as baby is being born…but I’m not likely to do anything at all during second stage in water births…blame it on me trying to protect my back and not wanting my shirt wet, but really it’s because the mother does it all on her own - and she knows best.
• I do not - nor does my wonderful assistant - usually touch the baby for a good hour or so after the birth. No routine checking the heart rate - we look and observe tone and respiratory effort. Only if that is in question will we come closer and do vitals or listen to heart rate.
• I typically do not do much face to face labor support, breathing reminders or talk women through labor contractions other than a very occasional gentle reminder of why she is doing this or that her body is working so well with her baby. If a woman needs more than that, I’m there, but my default is to stay in the background and support women to find their own way of laboring (and they have a tendency to breathe pretty well without instruction, too!) .
  

I have found myself fretting unproductively (since I haven’t had the chance to actually talk these things over with the midwife yet) about whether or not I would be able to have an undisturbed labor, birth, and especially third stage with a midwife present in the room. It’s this fruitless feedback loop of worry and anxiety that has been weighing heavily on me. On the one hand, I have had an unassisted birth and can’t really see how it could be improved upon. On the other hand, I have felt a need this time around to have access to a midwife, and I need to respect that as much as I listened to my need to have an unassisted pregnancy and birth with Zari. How can I reconcile my desire for an undisturbed birth with the presence of outsiders at my labor, when even having my own husband in the room felt distracting to me, made me feel self-conscious, like I was being watched, like how it feels when someone reads over your shoulder?

I talked over these things at length yesterday with my good friend Jen, who has experience both giving birth and attending births. She had her first baby in a birth center, her second at home with a CNM, and her third unassisted, with a midwife hired as a photographer. She is also apprenticing with a home birth midwife, so has seen birth from the other end of things, so to speak, including several more complicated/complex births. At the end of our conversation, she suggested that I, or this new baby, might need something that this midwife can offer. Perhaps my task this time is to learn how to move past my fears about having a midwife and to embrace this pregnancy and this birth journey for what it needs to be, rather than always comparing it against Zari’s pregnancy and birth. I think she was very wise to say this. Maybe there’s something unexpected that will arise during this pregnancy or birth that is spurring me to seek midwifery care. Maybe I need to learn how to let people into my life and accept assistance. I am a very independent, self-reliant person, and I always want to do things by myself. I have already proven that I can give birth alone, that I can do it all without assistance. Perhaps I don’t need go through that particular rite of passage this time.

I am eager to talk through these issues with the midwife the next time we meet, since I need to move beyond the unproductive anxiety that I have been feeling. I don’t like that this pregnancy has been so dominated by these unsettled concerns. Now that my birth is drawing nearer, I need to turn my emotional and mental energy in a more positive, productive direction, towards creating the birth that I desire rather than worry that it might not work out the right way. I know that my concerns are minor in the grand scheme of things—you know, compared to people dying of AIDS or extreme poverty or domestic violence or whatever—but they are still real and important to me.

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Born Free: Unassisted Childbirth in North America

My dissertation is online and publicly available!

I've been waiting for ProQuest to put my dissertation online. In the meantime, here is a link to the manuscript, Born Free: Unassisted Childbirth in North America (PDF document). It's actually a more recent version than the one I submitted to ProQuest, since I have recently changed several typos and made a few minor corrections. I'll be periodically updateding the manuscript as I find more typos or small items that need clarification or correction. Like any published book, the dissertation is copyrighted so, obviously, no quoting passages or paraphrasing without an appropriate citation.

I would love to have detailed feedback, comments, and/or criticism on the manuscript. Feel free to email me about anything from typos to major conceptual or organizational issues. My next project is submitting a proposal to publishers, so I would especially appreciate input related to turning the academic dissertation into a book.

Happy reading!

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Conference downloads on sale

All downloads from AAMI's 2008 Trust Birth Conference and the Helping Hands Conference are on sale through the end of December. This is a fantastic way to listen to speakers you've always wanted to hear. Some of the ones I'd really like to get:

• Heather Cushman-Dowdee (aka Hathor the Cow Goddess, aka Mama-Is): Telling Our Stories
• Pamela Hines-Powell: More of Them, Less of Me
• Why Women Stay Home Alone: Panel Discussion (I was on this and would like to have a recording of it for dissertation/book writing purposes).
  
• Rachel Correa: Stella's Life and Stillbirth

If I had to choose only one, it would be, hands down, Rachel Correa's talk about the stillbirth of her first baby. I can't even try to describe it so I will just say listen to it yourself. While she was speaking--about the stillbirth of her daughter Stella, about other parents of stillborn children, about her three other children's births--she showed photographs of these births and babies, of her family, of her grieving and healing process. If you buy this download, I'd recommend contacting Rachel about obtaining a copy of her Powerpoint to go along with her talk. I have no idea if she'd be willing to share the pictures, but I think the presentation is not complete without the images. She used my laptop during the presentation, so I am lucky to still have the slideshow on my computer.

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